Meckel's diverticulum: A challenging diagnosis

Objectives This single‐center, cross‐sectional study aims to elucidate the clinical presentation, diagnostic evaluation, and outcomes in a subset of pediatric patients with atypical and/or challenging presentations of Meckel's diverticulum. Methods We conducted a single‐center cross‐sectional study on children diagnosed with Meckel's diverticulum at Children's Health in Dallas, Texas between 2010 and 2022. We identified 11 patients aged 0–17‐years‐old with confirmed Meckel's diverticulum who presented with atypical symptoms and/or a challenging diagnostic course. Patient demographics, symptoms at presentation, diagnostic workup, time to diagnosis, management, and outcomes were collected. Descriptive statistics were utilized. Results Eleven patients (n = 8, 73% male) were included in the study with an average age of 10.5 years (range: 1–17 years). The mean time interval from initial presentation of symptoms to diagnosis was 8 months (range: 0–33 months). Barriers to diagnosis of Meckel's diverticulum identified in our study included atypical presentations, negative or nonconfirmatory Meckel scan results, negative surgical findings, and competing differential diagnoses. Conclusion Meckel's diverticulum is a challenging diagnosis and should be considered even if initial evaluation is negative as certain patients exhibit atypical presentations that necessitate surgical intervention for diagnosis. What is Known Meckel's diverticulum classically presents in pediatric patients with painless rectal bleeding. Technetium‐99m pertechnetate scan (Meckel's scan) is the most common initial diagnostic modality for Meckel's diverticulum. Meckel's diverticulum can lead to complications such as obstruction, perforation, and intussusception, and so forth. What is New Diagnosis of Meckel's diverticulum can be challenging due to atypical clinical presentations, negative or unusual diagnostic testing, complex medical history, competing differential diagnoses, and negative surgical findings. Surgical intervention is the cornerstone for diagnosis and treatment of Meckel's diverticulum in challenging cases.